Apparatuses and methods for making a final hybrid prosthesis to be attached to dental implants

ABSTRACT

The present invention includes apparatuses and methods for making a final hybrid prosthesis to be attached to one or more dental implants. One preferred method includes the step of making a temporary hybrid prosthesis and at about the same time also making a duplicate temporary hybrid prosthesis. The duplicate temporary hybrid prosthesis permits the final hybrid prosthesis to be made with fewer visits to a restorative dentist and with less dental laboratory time than is currently needed when making a final hybrid prosthesis.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.61/784,908, filed Mar. 14, 2013, which is hereby incorporated byreference herein in its entirety.

FIELD OF THE INVENTION

The present invention pertains to the field of dental implants.

BACKGROUND OF THE INVENTION

Dental implants are implanted into the jawbone of a patient that haslost some or all of his or her teeth in that jawbone. Various proceduresexist for fabricating teeth to be attached to those implants. Oneprocedure currently used is known as the “immediate load protocol.” Inthe immediate load protocol as currently carried out, a patient receivesa “temporary hybrid prosthesis” (also referred to as “temporary hybrid”)including temporary teeth during the surgical visit during which dentalimplants are implanted into the jawbone by an implant surgeon. Thetemporary hybrid includes temporary teeth and metal temporary cylinders.Screws are used to attach the temporary hybrid to the implants. Thesescrews go through bores in the temporary cylinders and screw intothreads in the implants. However, the metal cylinders are not connectedto one another with metal, but rather are connected to one another withless sturdy acrylic material that is typically used to hold a denture(which includes a set of artificial teeth for one jaw) together. Theprocedure for making a temporary hybrid under the immediate loadprotocol as currently carried out is described in detail in the sectionbelow entitled “Procedure for Making a Temporary Hybrid Prosthesis to BeInstalled in a Patient's Mouth.”

After having dental implants implanted, it typically takes severalmonths for the implants to fuse to the patient's jawbone, a processknown as “osseointegration.” During this time, the tissue in thepatient's mouth heals, and the post-surgical swelling goes down. At thatpoint, a patient is ready to have a “final hybrid prosthesis” (alsoknown as a “final hybrid”) of teeth made and installed in his or hermouth. This final hybrid differs from the temporary hybrid primarily inthat the metal cylinders in the hybrid are attached to one another witha metal bar, such that the cylinders and the bar form one extremelysturdy, integral piece. The final hybrid replaces the temporary hybridand is intended to more or less be permanently installed in thepatient's mouth.

In the immediate load protocol as currently carried out, it takes atleast five (and usually more) visits to a restorative dentist (after thesurgical visit in which the implant surgeon implants the dental implantsin the patient's mouth) to fabricate the final hybrid and have itinstalled in the patient's mouth. These five or more visits to arestorative dentist typically occur over a period of several months. Asignificant amount of dental laboratory time occurs between thesevisits, where the final hybrid is designed, fabricated and perfectedbased on information obtained during the visits to the restorativedentist. For this reason (and also due to patient and dentistavailability), the five or more visits to a restorative dentist must bescheduled over a period of several months. The work done during each ofthese visits to the restorative dentist, as well as the work done by thedental laboratory between the visits, is described in detail in thesection below entitled “Manufacture of Final Hybrid Without DuplicateTemporary Hybrid.”

Having to visit a restorative dentist five or more times over severalmonths to have the final hybrid fabricated and installed is inconvenientand expensive to patients, many of whom do not have insurance to helpwith the costs of dental implants. Moreover, patients who have atemporary hybrid in their mouths are limited in what they are able toeat because the temporary hybrid is not as sturdy as the final hybrid,and thus patients are eager to get the final hybrid installed as quicklyas possible. Thus, there is a need for methods that would allow for thefinal hybrid to be fabricated and installed that require fewer visits toa restorative dentist and could be done in less time, and a need forapparatuses to be used in those methods.

Even when an immediate load protocol is not used, there is still a needfor methods by which a final hybrid prosthesis can be made with fewervisits to a restorative dentist and in a shorter period of time, and aneed for apparatuses for use in those methods.

SUMMARY OF THE INVENTION

The present invention addresses the drawbacks of current protocols forfabricating a final hybrid prosthesis by permitting such a prosthesis tobe fabricated and installed in fewer visits to a restorative dentist,over a shorter period of time, and with less dental laboratory time. Forexample, the present invention addresses the drawbacks of the immediateload protocol as currently carried out by allowing a final hybrid to befabricated and installed with just two visits to a restorative dentist(instead of five or more visits), and over a period of just a few weeks.The amount of dental laboratory time needed to design, fabricate andperfect the final hybrid is also significantly reduced.

In accordance with one aspect of the present invention, this isaccomplished by the fabrication of a “duplicate temporary hybridprosthesis” (also known as a “duplicate temporary hybrid”) at the sametime that the first temporary hybrid is fabricated and installed in thepatient's mouth, which is during the surgical visit during which thedental implants are implanted into the patient's jawbone in theimmediate load protocol as currently carried out. This duplicatetemporary hybrid may be fabricated during time when the patient wouldotherwise still be recovering at the place of the surgery, and thus doesnot add any appreciable amount of time to the length of the surgicalvisit when the dental implants are implanted in the patient's mouth.

In accordance with another aspect of the present invention, theduplicate temporary hybrid is used to simplify and shorten the processof making the final hybrid. Whereas five or more visits to a restorativedentist over a period of several months are required to fabricate andinstall a final hybrid under the immediate load protocol as currentlycarried out, only two visits to a restorative dentist over a period ofjust a few weeks are required when the duplicate temporary hybridaccording to the present invention is utilized.

According to some implementations of the present disclosure, a method ofmaking a final hybrid prosthesis to be attached to one or more dentalimplants in a patient's mouth includes making a temporary hybridprosthesis to be attached to one or more dental implants in a patient'smouth. A duplicate temporary hybrid prosthesis is made. The duplicatetemporary hybrid prosthesis is used in making the final hybridprosthesis.

According to some implementations of the present disclosure, a duplicatetemporary hybrid prosthesis for use in making a final hybrid prosthesisincludes a unitary structure in the shape of teeth and gum portions of atemporary hybrid prosthesis to be attached to dental implants in apatient's mouth. The unitary structure is made entirely of one type ofmaterial.

According to some implementations of the present disclosure, a method ofmaking a final hybrid prosthesis to be attached to a plurality of dentalimplants in a patient's mouth includes making a temporary hybridprosthesis to be attached to the plurality of dental implants in thepatient's mouth. By use of the temporary hybrid prosthesis, a stonemodel of the patient's mouth is developed. By use of the stone model, aduplicate temporary hybrid prosthesis is developed. After soft tissueadjacent to the plurality of dental implants has healed, the duplicatetemporary hybrid prosthesis is attached to the plurality of dentalimplants. While the duplicate temporary hybrid prosthesis is attached tothe dental implants, impression material is used to identify thecontours of the healed soft tissue. An updated stone model is createdwith the healed soft-tissue contours identified by the impressionmaterial. The final hybrid prosthesis is made by use of the updatedstone model and the duplicate temporary hybrid prosthesis.

BRIEF DESCRIPTION OF THE DRAWINGS

Specific examples have been chosen for purposes of illustration anddescription, and are shown in the accompanying drawings, forming a partof the specification.

FIG. 1 illustrates a temporary hybrid prosthesis to be installed in thepatient's mouth on a working model of one of the patient's jawbones.

FIG. 2 illustrates soft tissue material and temporary cylinders on aworking model of one of the patient's jawbones.

FIG. 3 illustrates acrylic material being poured into an impression (ormatrix) of the temporary hybrid prosthesis to be installed in thepatient's mouth.

FIG. 4 illustrates an articulator with one jaw being composed of theimpression (or matrix) with acrylic material in it on top of a workingmodel of one of the patient's jawbones.

FIG. 5 illustrates a duplicate temporary hybrid prosthesis attached to aworking model of one of the patient's jawbones.

FIG. 6 illustrates the duplicate temporary hybrid prosthesis attached tothe dental implants in a patient's mouth, and impression material beingsquirted into the gap between the duplicate temporary hybrid prosthesisand the patient's healed gums.

FIG. 7 illustrates the duplicate temporary hybrid prosthesis with theimpression material of FIG. 6 on it after it has been removed from thepatient's mouth.

FIG. 8 is a CAD drawing showing the metal bar inside the outline of thefinal hybrid prosthesis.

FIG. 9 illustrates the final hybrid prosthesis made according to thepresent invention after it has been inserted in a patient's mouth.

DETAILED DESCRIPTION

Procedure for Making Temporary Hybrid Prosthesis to be Installed inPatient's Mouth

The typical procedure for making a temporary hybrid prosthesis to beinstalled in the patient's mouth under the immediate load protocol ascurrently carried out proceeds in the following manner. Several weeksbefore the surgical visit where the patient is to have dental implantsimplanted by an implant surgeon, a restorative dentist takes impressionsof the patient's upper and lower teeth using techniques familiar tothose skilled in the art. The dentist also measures the verticaldimension of occlusion (“VDO”) of the patient's jaws, and takes a“bite,” which is an impression of the interface between the patient'supper and lower teeth. These impressions, the VDO information and thisbite are used by a dental laboratory to build a working model of thepatient's upper and lower jaws with teeth. The model may then be used tomake a “lab bite,” which is an impression of the interface between theupper and lower teeth in the model.

The impression of the teeth to be replaced is also used by the dentallaboratory to make a temporary denture that will be used in making thetemporary hybrid. The temporary denture does not have any metalcylinders in it, nor does it have any holes in it to facilitateattachment to the implants. The teeth in the temporary denture aredenture teeth (or hybrid teeth, which are stronger) that are typicallyheld together with pink acrylic material (which forms the “gums” of thedenture). The temporary denture is typically the shape of a horseshoewith the middle part of the horseshoe filled in (i.e., the shape of halfof an oval).

During the surgical visit where dental implants are implanted by theimplant surgeon, impression material is placed onto the temporarydenture on the side facing the implants, and the temporary denture isplaced into the patient's mouth. This impression material records theprecise location and orientation of the implants. Using the indexcreated by the impression material, holes are cut in the temporarydenture that match up with the location of the implants in the patient'smouth. When a patient is having all of his or her teeth on one jawbonereplaced, it is typical for five dental implants to be implanted in thatjawbone. When, for example, five dental implants are implanted in onejawbone, holes are cut in the temporary denture that match up with thelocation of the implants in the patient's mouth. Next, temporary metalcylinders are attached to the implants with screws. The holes in thetemporary denture are just large enough to allow the temporary metalcylinders to slide through them. After the temporary metal cylinders areattached to the implants with screws, a horseshoe-shaped rubber dam islaid down on top of the patient's gum with holes in it to allow thetemporary metal cylinders to fit through the rubber dam. The index thatwas previously used to ensure that the holes in the temporary denturewere made in the proper location may also be used to ensure that theholes in the rubber dam are made in the proper location. This rubber damprotects the patient's gum during the next step.

In this next step, acrylic is applied to the temporary cylinders. Anysuitable acrylic may be used. One suitable acrylic is made by mixing Jetacrylic polymer (a powder) with Jet acrylic monomer (a liquid). Therubber dam prevents acrylic from coming in contact with the patient'sgums. Next, the temporary denture (with the holes in it that correspondto the locations of the temporary cylinders) is placed into thepatient's mouth with the temporary denture contacting the rubber dam andthe temporary cylinders protruding through the holes in the temporarydenture. The relationship of the two jaws is stabilized using the biteor lab bite previously made. The acrylic is allowed to at leastpartially dry and harden, which happens very rapidly. The dried acrylicattaches the temporary cylinders to the temporary denture. The screwsholding the temporary cylinders onto the implants are removed and thetemporary denture—with the temporary cylinders now attached—is removedfrom the patient's mouth. The rubber dam typically remains attached tothe temporary denture when that is removed (because of the acrylic). Ifthat happens, the rubber dam is pulled off of the temporary denture. Thetemporary denture with the temporary cylinders now affixed to it maythen be cured in a pressure pot in warm water (such as at 20 psi for 5minutes) to make the unit sturdier. The plastic material that connectsopposite sides of the horseshoe (i.e., that “fills in” the horseshoe) isthen cut away, leaving a horseshoe-shaped temporary hybrid. The flangeof the denture that covers the patient's gums is also cut away. Thishybrid is then polished up and installed in the patient's mouth. Theaccess holes in the denture for the screws are filled in with rubberplugs so that food does not get stuck into the access holes. Theserubber plugs can be removed later to unscrew the screws and therebyremove the temporary hybrid from the patient's mouth.

In this manner, in the immediate load protocol as currently carried out,the process of taking a temporary denture and turning it into atemporary hybrid prosthesis that may be installed in the patient's mouth(as well as the actual installation of the temporary hybrid) occursduring the surgical visit when the dental implants are implanted.

This procedure for making a temporary hybrid prosthesis is generallydescribed in BIOMET 3I, Diem 2 Guidelines, Rev. A (11/11), which isincorporated herein by reference.

Procedure for Making Duplicate Temporary Hybrid Prosthesis

As referred to above, the present inventor has discovered thatsubstantial benefits may be obtained if a duplicate temporary hybridprosthesis is fabricated at the same time that the temporary hybrid tobe installed in the patient's mouth is fabricated. This duplicatetemporary hybrid is fabricated in the following manner.

After the temporary hybrid to be installed in the patient's mouth isfabricated (as described above), but during the surgical visit when thedental implants are implanted into the patient, “implant analogs” areattached to the temporary cylinders of the temporary hybrid with screws,just as the temporary cylinders would be attached to the implants in thepatient's mouth with screws. These implant analogs are meant to performthe same function in a working model of the patient's mouth that the“real” implants perform in the patient's real mouth. A thin layer ofsoft tissue material—silicone that is intended to mimic the contour andtexture of the gums—is then squirted onto the side of the temporaryhybrid from which the implant analogs protrude and allowed to dry. Anytype of soft tissue material may be used, but one particularly preferredtype of soft tissue material is Coltene Gi-Mask #8065 from BENCO. Thetemporary hybrid with the soft tissue material and analogs attached isthen pressed into a patty of fast-setting dental stone (with the teethprotruding away from the dental stone and the analogs protruding towardthe dental stone). Any type of dental stone may be used, but oneparticularly preferred type of dental stone is Mounting Stone White IOSType 3 #095021202 by WHIP MIX. The stone is allowed to dry and harden,leaving a working model of one half of the patient's jaw with thetemporary hybrid attached to it.

FIG. 1 depicts this working model. Temporary hybrid prosthesis 1includes teeth 2 and gums 5 from the temporary denture. The temporaryhybrid prosthesis 1 also includes the holes 4 that were cut into thetemporary denture to align with the dental implants in the patient'smouth. In FIG. 1, one can see the tops of the temporary cylinders 3poking out of the holes 4. In the working model, temporary hybridprosthesis 1 is mounted on hardened dental stone 7 (which mimics thejawbone), and is separated from the stone by a thin layer of soft tissuematerial 6, which mimics the patient's gums with which the temporaryhybrid prosthesis will interface. Screws go through bores in each of thetemporary cylinders 3 and screw into threads on the implant analogs (notshown) embedded in the dental stone, which mimics the dental implants inthe patient's mouth.

The temporary hybrid may be removed by unscrewing the screws holding thetemporary cylinders to the implant analogs. This leaves hardened dentalstone with a thin horseshoe-shaped layer of soft tissue material on thesurface of the dental stone, with the implant analogs protruding fromthe stone and through the horseshoe-shaped soft tissue material. Thismimics the half of the patient's jaw to which the temporary hybrid is tobe attached.

As mentioned previously, before the surgical visit where the dentalimplants are implanted, impressions of the patient's upper and lowerteeth and a bite are made using techniques familiar to those skilled inthe art, and VDO information is collected, and the impressions, bite andVDO information are used to build a working model of the patient's upperand lower jaws with teeth. The upper and lower jaws of the model areplaced in relation to one another with an “articulator,” which can beused to orient the upper and lower jaws so that they are in the samerelationship that they are in the patient's mouth (e.g., with the properVDO, and with the proper horizontal relationship of the upper and lowerjaws, or “centric relation”). Any suitable articulator may be used, suchas hinged articulators sold by HARRIS. A pin on the upper jaw isunscrewed to a length so that it just contacts a plate on the lower jawwhen the two jaws are closed. This pin is used to make sure that thevertical distance between the upper and lower jaws is consistent withthe VDO information previously recorded. The bite made previously isused to ensure that the horizontal relationship between the upper andlower jaws is correct. The articulator has a hinge on it that permitsthe jaws to be opened just like a human mouth. In this way, thearticulator with the representations of the upper and lower jawsincluded in it provides a good working model of the patient's mouthbefore the dental implants or the temporary hybrid are installed.

After the temporary hybrid is fabricated, and after that temporaryhybrid and dental stone are used to fabricate a new model of the half ofthe patient's jaw to which the temporary hybrid is to be attached (asdescribed above), the articulator is used to orient this new model ofthe half of the patient's jaw to which the temporary hybrid is attachedwith the existing model of the other half of the patient's jaw. One canensure that the temporary hybrid provides the proper VDO by checking tosee that the pin on the representation of the upper jaw just touches theplate on the model of the lower jaw. Similarly, one can ensure that thetemporary hybrid provides the proper centric relation by using the biteor lab bite. In this way, the articulator with the representation ofeach half of the patient's jaw attached to it provides a good workingmodel of the patient's mouth after the temporary hybrid is installed.

To make the duplicate temporary hybrid, the temporary hybrid to beinstalled in the patient's mouth is attached to the representation ofthe half of the patient's mouth to which the temporary hybrid will beattached (the dental stone with soft tissue material and implantanalogs) with screws that go through the temporary cylinders and screwinto the implant analogs. This is depicted in FIG. 1. Next an impression(or matrix) is taken of the temporary hybrid using lab putty in a mannerfamiliar to those skilled in the art. The impression (or matrix) madewith lab putty is then removed and set aside. Next the temporary hybridis removed from the representation of the half of the patient's mouth towhich the temporary hybrid will be attached by unscrewing the screwsholding the temporary cylinders to the implant analogs. Next, newtemporary cylinders are attached with screws to the implant analogs inthe model of the patient's mouth. These are cut down to size so that theVDO will be the same in the patient's mouth with the temporary hybrid tobe installed in the patient's mouth and the duplicate temporary hybrid.The access holes in the temporary cylinders are blocked. A separatormaterial such as petroleum jelly is applied to the dental stone, softtissue material and analogs on the model of the patient's jaw to preventacrylic from sticking to the dental stone, soft tissue material oranalogs.

FIG. 2 depicts the model of the patient's jaw with the temporarycylinders 8 to be used in making the duplicate temporary hybridprosthesis protruding from the hardened dental stone 7 and through thesoft tissue material 6. The access holes 9 at the top of the temporarycylinders are blocked.

The impression (or matrix) made of lab putty is now filled with softacrylic. FIG. 3 depicts acrylic 11 being poured into impression (ormatrix) 10. This impression (or matrix) is made by pressing the labputty onto the surface of the temporary hybrid prosthesis 1.

The impression (or matrix) is placed onto the model of the patient's jawto which the temporary hybrid is to be installed (which is itselfattached to the articulator) so that the temporary cylinders are stuckinto the soft acrylic. The articulator is closed so that the VDO iscorrect, and the two jaws are secured to one another in some manner(e.g., with a rubber band). Note that the closing of the articulator maycause the teeth from the jaw that is not being repaired to cut a smallhole in the lab putty holding the soft acrylic. For this reason, aseparator material (such as petroleum jelly) is placed onto the teeth ofthe jaw that is not being repaired so that acrylic does not stick tothose teeth. The acrylic dries and hardens.

FIG. 4 depicts an articulator 15 that includes a model of the patient'sopposing jaw (the jaw that is not being repaired) 12, and the model ofthe patient's jaw that is being repaired including hardened dental stone7 and impression (or matrix) 11 with the acrylic that was poured intothe impression (or matrix) in FIG. 3 inside of it. A pin 13 is attachedto the model of the upper jaw, and a metal plate 14 is attached to themodel of the lower jaw. The length of the pin can be adjusted so thatthe distance between the upper and lower jaws is the same as in thepatient's mouth. The VDO for the model is correct when the pin justcontacts the metal plate.

The articulator with the acrylic-containing matrix forming one of thetwo jaws and the model of the other jaw may be placed in a pressure potto make the acrylic stronger (e.g., at 20 psi for 5 minutes in warmwater). The impression or matrix is removed from the hardened acrylic.The temporary cylinders are now firmly embedded in the hardened acrylic.The hardened acrylic with the temporary cylinders embedded in itconstitutes the duplicate temporary hybrid.

FIG. 5 depicts the duplicate temporary hybrid 16 after the impression(or matrix) has been removed. It is attached to the working model of thepatient's jaw, which includes hardened dental stone 7 and soft tissuematerial 6. There are holes 17 in the duplicate temporary hybrid thatlead to the temporary cylinders and screws.

The screws holding the temporary cylinders to the implant analogs areaccessed by removing the material used to block the access holes in thetemporary cylinders and any acrylic needed to be removed, and the screwsare unscrewed so that the temporary cylinders may be unfastened from theimplant analogs. This leaves a duplicate hybrid made out of acrylic,with temporary cylinders in it at the same locations and in the sameorientations as the temporary cylinders in the temporary hybrid to beinstalled in the patient's mouth.

This duplicate temporary hybrid is then polished up in the same manneras the temporary hybrid to be installed in the patient's mouth. Beforethe surgical visit where the dental implants are implanted is over, therestorative dentist installs the duplicate temporary hybrid in thepatient's mouth to make sure that it fits in the same way as thetemporary hybrid to be installed in the patient's mouth. In particular,the restorative dentist makes sure that the placement and orientation ofthe temporary cylinders on the duplicate temporary hybrid are correct,and that the VDO and centric relation of the temporary hybrid arecorrect.

In this manner, a duplicate temporary hybrid (with teeth made out ofacrylic) may be fabricated during the surgical visit during which dentalimplants are implanted in the patient. Although referred to herein as a“duplicate” temporary hybrid, this hybrid is actually different from thetemporary hybrid to be installed in the patient's mouth in that theteeth and gum portions of the duplicate temporary hybrid are madeentirely out of one type of material (e.g., acrylic), whereas in thetemporary hybrid to be installed in the patient's mouth, the teethportions are made out of one type of material (e.g., denture teeth orhybrid teeth) while the gum portions are made out of a different type ofmaterial (e.g., pink acrylic). In one embodiment, white acrylic is usedto make the duplicate temporary hybrid so that if the duplicatetemporary hybrid is ever needed to replace the temporary hybrid to beinstalled in the patient's mouth (because, for example, the temporaryhybrid to be installed in the patient's mouth is damaged), it willappear similar to the duplicate temporary hybrid to be installed in thepatient's mouth (i.e., it will have white “teeth”).

The temporary cylinders included in the duplicate temporary hybrid mayeither be the same type of temporary cylinder included into thetemporary hybrid to be installed in the patient's mouth, or they may bea different type of temporary cylinder. For example, while the temporarycylinders included in the temporary hybrid to be installed in thepatient's mouth must be anodized and approved by regulatory authoritiessuch as the Food and Drug Administration (FDA) to be placed in thepatient's mouth for an extended period of time (at least six months),the temporary cylinders included in the duplicate temporary hybrid donot need to be anodized or approved by regulatory authorities to beplaced in the patient's mouth for an extended period of time.Accordingly, the temporary cylinders included in the temporary hybrid tobe installed in a patient's mouth can be less expensive than thetemporary cylinders included in the temporary hybrid to be installed ina patient's mouth.

The fabrication of the duplicate temporary hybrid does not addappreciably to the length of the surgical visit because during the timethat the duplicate temporary hybrid is made, the patient is typicallyrecuperating in a post-operative room. The only additional time neededfrom the patient is the minimal amount of time needed for the duplicatetemporary hybrid to be installed to make sure that it fits properly inthe patient's mouth. During the surgical visit, it takes less than anhour of dental laboratory time to make the duplicate temporary hybrid.

Use of Duplicate Temporary Hybrid in Making Final Hybrid

As referred to previously, the process of making a final hybridcommences after the implants have become firmly attached to thepatient's jawbone (osseointegration), and after patient's gums havehealed and stopped swelling. At this point, the duplicate temporaryhybrid made during the surgical visit (when the dental implants wereimplanted) can be used to make a final hybrid with just two patientvisits to the restorative dentist.

Since the surgical visit when the dental implants were implanted, theswelling in the patient's gums will have gone down. Thus, a gap betweenthe temporary hybrid that the patient has been wearing and the patient'sgums will have developed. There will be an identical gap between thepatient's gums and the duplicate temporary hybrid when the latter isinstalled in the patient's mouth.

During the first visit to the restorative dentist after the surgicalvisit in which the dental implants were implanted, the temporary hybridthat the patient has been wearing is removed, and the duplicatetemporary hybrid is screwed onto the dental implants. The VDO andcentric relation with the duplicate temporary hybrid are then checked.Whether the duplicate temporary hybrid fits properly onto the implantsis also checked.

The duplicate hybrid is then removed, and adhesive is applied to thesurface of the duplicate temporary hybrid that contacts the patient'sgums. One appropriate adhesive is Vinyl-Polysiloxane Tray Adhesive. Theduplicate temporary hybrid (with the adhesive applied to it) is thenscrewed onto the implants. Now impression material is squirted into thegaps between the patient's gums and the surface of the duplicate hybridwith adhesive attached to it. The adhesive helps attach the impressionmaterial to the duplicate hybrid. One appropriate type of impressionmaterial is Vinyl Polysiloxane Impression Material, Regular Set-LightBody-Hydrophilic, ISO 4823 Type 3 (50 ml Base Paste/Catalyst Paste) madeby 3M.

FIG. 6 depicts the duplicate temporary hybrid 16 installed in apatient's mouth after osseointegration has occurred and the swelling inthe patient's gums has gone down. Because the swelling in the gums hasgone down, there is a gap 19 between the duplicate temporary hybrid andthe patient's gums 18. Impression material 20 is injected into this gap19.

The impression material is allowed to harden, and then the duplicatetemporary hybrid is removed from the patient's mouth. Note that thehardened impression material provides an impression of the patient'sgums (i.e., the healed gums) to which the final hybrid will be attached.

FIG. 7 depicts the duplicate temporary hybrid prosthesis 16 after theimpression material 20 has hardened and the duplicate temporary hybridhas been removed from the patient's mouth. The top surface 21 of theimpression material 20 provides an impression of the contour of thepatient's healed gums.

The temporary hybrid that the patient has been wearing is re-installed.This ends the first visit to the restorative dentist.

The duplicate temporary hybrid with the impression material attached toit is then used to update the model of the half of the patient's jaw towhich the temporary hybrid is attached in the following manner. At thispoint, the model consists of hardened dental stone covered by a thinlayer of soft tissue material in a horseshoe shape with one end of theimplant analogs embedded in the dental stone and the other endprotruding through the soft tissue material. This soft tissue materialmimics the contour and texture of the patient's gums at the time of theimplant procedure, when they were swollen. Since it is no longernecessary to mimic the gums in this swollen state, the soft tissuematerial is removed from the model. Any excess impression material(i.e., impression material that was not in contact with the patient'sgums) is trimmed away. The duplicate temporary hybrid with theimpression material attached to it is now screwed onto the model of thehalf of the patient's jaw to which the temporary hybrid is attached. Newsoft tissue material is squirted into the void between the dental stoneand the trimmed impression material (which contains an impression of thehealed gum tissue). The soft tissue material is allowed to harden. Whenthe duplicate temporary hybrid is removed, the soft tissue materialstays behind on the dental stone (due to the friction between the softtissue material on the one hand and the crevices in the stone andimplant analogs on the other), leaving a model of the half of thepatient's jaw to which the temporary hybrid is attached as it now exists(e.g., with unswollen gums).

Now, a computer scanner is used to make a three-dimensional drawing ofthe duplicate temporary hybrid attached to a representation of thesurface of the patient's mouth to which it will be attached. Anysuitable computer scanner may be used. Suitable computer scanners aremade by 3SHAPE. The three-dimensional drawing represents the shape ofthe final hybrid that will be installed in the patient. A computer-aideddesign (CAD) program is used to design a sturdy horse-shoe shaped barthat will fit inside the gum portion of the final hybrid and that willinclude cylinders in locations that match up properly with the dentalimplants. Any suitable CAD program may be used. Suitable CAD programsare sold by 3SHAPE. The bar is often made of titanium.

FIG. 8 depicts a CAD drawing 25 including a representation 22 of thefinal hybrid prosthesis and a representation 24 of the surface to whichit will be attached in the patient's mouth. The representation 22 of thefinal hybrid prosthesis is translucent so that a representation of themetal bar 23 can be seen inside of the representation of the finalhybrid prosthesis. The cylinders that match up with the dental implantsare found on the bottom of the bar. Protrusions on the upper side of thebar help hold the teeth in place.

Once the design of this bar has been determined using the CAD program,an actual bar is made with a milling machine using the design determinedon the computer. Such bars will be familiar to those skilled in the art,and are manufactured by companies such as BIOMET 3I.

Once the bar is manufactured, it is checked to make sure it properlyfits onto the model of the patient's jaw to which the temporary hybridis attached by screwing it onto that model by putting screws through thecylinders on the bar and screwing them into the implant analogs on themodel. This shows the relationship between the bar and the soft tissuematerial, which represents the relationship between the bar and thepatient's gums.

Next, denture teeth (or hybrid teeth, which are stronger than dentureteeth) are attached to the bar using wax using techniques familiar tothose skilled in the art. Any suitable type of denture or hybrid teethmay be used. One such type of teeth is Heraeus Mondial® teeth. Anysuitable wax may be used, such as pink denture wax. The bar with theteeth attached to it with wax is then screwed onto the model and checkedto see whether the VDO and centric relation are correct. At that point,the bar with teeth attached to it with wax is pressed into soft dentalstone in a denture flask (or brass bowl). The stone hardens, and the waxis then boiled out. This leaves just the bar and the teeth, but withoutanything holding the teeth to the bar. The stone in the denture flaskholds the bar and the individual teeth in place. A thin layer of pinkopaque material that is the color of the patient's gums is spread ontothe bar so that the bar is not visible through the acrylic gums whenlooking at the final hybrid. Such materials are familiar to thoseskilled in the art, including Tru-Paque® acrylic liquid opaque material.Then soft acrylic (which is the pink color of gums) is put into thedenture flask and allowed to harden around the bar and the teeth. Thehardened acrylic holds the bar to the teeth and vice versa, and also isdesigned to look like the patient's natural gums. The bar with thehardened acrylic and teeth constitutes the final hybrid. This finalhybrid is polished. It is then attached to the jaw model to make surethat it fits properly and that the VDO and centric relation are correct.

At the second visit with the restorative dentist, the temporary hybridis removed, and the final hybrid is installed. The holes for the screwsare filled in, and the process is complete.

FIG. 9 depicts a final hybrid prosthesis 30 that has been screwed into apatient's mouth. The final hybrid includes teeth 26 and acrylic gums 27.Holes 29 in the final hybrid allow one to access screws 28 that protrudethrough the cylinders on the metal bar and attach the final hybrid tothe dental implants. These holes are filled in with composite materialby the restorative dentist. It should be noted that while the inventiveprocess involving the duplicate temporary hybrid prosthesis of thepresent invention has been described relative to hybrid bars, theprocess and the duplicate temporary hybrid prosthesis can also beapplied to copy milled bars.

In this manner, the procedure for fabricating and installing a finalhybrid takes only two visits to the restorative dentist.

Manufacture of Final Hybrid without Duplicate Temporary Hybrid

In contrast, after osseointegration is complete, five or more visits tothe restorative dentist are required to make a final hybrid prosthesisin the immediate load protocol as typically carried out. This protocolis generally described in BIOMET 3I Restorative Manual (CATRM),Flexibility By Design.

In the first visit to the restorative dentist in the immediate loadprotocol as it is currently carried out, the temporary hybrid is firstremoved. Then metal devices referred to as impression copings areattached to the implants with screws. These impression copings looksimilar to the temporary cylinders that are located inside the temporaryhybrid. A custom tray is then filled with impression material and placedonto the jaw with the impression copings screwed into the implants. Thescrews holding the impression copings to the implants are then unscrewed(through access holes in the custom tray), and the custom tray withimpression material and impression copings in it is removed. Thetemporary hybrid is re-attached to the patient's mouth, completing thefirst visit.

The impression material with the impression copings in it is now givento the dental laboratory. Implant analogs are attached to the impressioncopings with screws. Soft tissue material is applied to the surface ofthe impression material that interfaced with the patient's gums. Thenthe impression material with impression copings, implant analogs andsoft tissue material is pressed into a patty of dental stone. After thedental stone hardens, the impression copings and the impression materialare removed by unscrewing the screws holding the impression copings ontothe implant analogs. This leaves a model of the patient's jaw, with athin, horse-shaped layer of soft tissue material on the hardened dentalstone, with implant analogs protruding from the dental stone through thelayer of soft tissue material.

At this point, a set of temporary cylinders is screwed onto the model. Ahorseshoe-shaped bar of acrylic is used to connect the temporarycylinders to one another. This device—the temporary cylinders connectedto one another by a horseshoe-shaped acrylic bar—is commonly referred toas a “verification jig” (or “verification index”).

Next, a sheet of acrylic is placed on the model of the jaw beingrepaired composed of dental stone, implant analogs and soft tissuematerial. Light is shone on this layer of acrylic to cure it. This layerof acrylic is known as a “base plate.” An approximately ½ inch layer ofwax in the shape of a horseshoe is then formed on the base plate. Thisdevice, composed of the base plate plus the wax horseshoe, may bereferred to as a “VDO device” or a “base plate with an occlusal rim.”Now it is time for the second visit to the restorative dentist. It takesapproximately 2.5 hours of dental laboratory time between the first andsecond visits to the restorative dentist under the immediate loadprotocol as currently carried out.

During the second visit, after removing the temporary hybrid, therestorative dentist attaches the verification jig to the implants withscrews and checks to see that it fits properly. In this way, therestorative dentist uses the verification jig to verify that the spacingand orientation of the temporary cylinders in the model (which will beused to fabricate the final hybrid) is correct.

Also on the second visit, the VDO device is placed into the mouth like atraditional denture (on the jaw that is being repaired), and the patientbites into the horseshoe-shaped wax material.

Also on the second visit, the restorative dentist will take animpression of the patient's jaw that is not being repaired.

The temporary hybrid is then screwed back into the implants, thuscompleting the second visit. This visit takes approximately 1.5 hours of“chair time” with the restorative dentist.

After the second visit to the restorative dentist, the dental laboratoryuses the impression of the patient's jaw that is not being repaired tomake a stone model of that jaw.

The dental laboratory also takes the VDO device (i.e., the base platewith an occusal rim) and places it onto the model of the patient's jawthat is being repaired that was made after the first visit to therestorative dentist. This is the hardened dental stone with the thinlayer of horseshoe-shaped soft tissue material on its surface, and withthe implant analogs embedded into the stone and protruding through thesoft tissue material. Both jaw models are placed into an articulator(including the model of the jaw that is being repaired with the VDOdevice attached to it), and the VDO device is used to properly set theVDO between the two jaws in the articulator.

Next the wax is removed from the VDO device and a set of denture teeth(or hybrid teeth) is attached to the base plate with wax. Now it is timefor the third visit to the restorative dentist. It takes approximately 2hours of dental laboratory time between the first and second visits tothe restorative dentist under the immediate load protocol as currentlycarried out.

During the third visit, the dentist removes the temporary hybrid, andinserts the base plate with the teeth attached to it with wax. The teethon the base plate should occlude properly with the opposing set of teethin the patient's mouth. This step—checking the occlusion using the baseplate with teeth attached to it with wax—is commonly referred to as awax “try in.”

The base plate with teeth attached to it with wax is removed from thepatient's mouth, and the temporary hybrid is re-attached using screws.This completes the third visit. This visit takes approximately 1 hour ofchair time with the restorative dentist.

At this point, the dental laboratory uses the base plate with the teethattached to it with wax to design a metal bar to be used in the finalhybrid using a computer scanner and CAD program as described above. Thecomputer scanner and CAD program can be set to make the teeth and wax betranslucent, while the model is opaque, which facilitates the design ofa metal bar that will fit within the teeth and wax, and that will matewith the model.

After the metal bar is designed, it is fabricated using a millingmachine as described above. Then teeth are attached to the metal barusing wax.

Now it is time for the fourth visit to the restorative dentist. Duringthe fourth visit, the restorative dentist removes the temporary hybridand checks to make sure that the titanium bar with the teeth attached toit with wax fits properly. The temporary hybrid is re-attached to thepatient's mouth with screws, thus completing the fourth visit. Thisvisit takes approximately 1 hour of chair time with the restorativedentist.

The dental laboratory then removes the wax by boiling it out, andreplaces the wax with acrylic (as described above). This constitutes thefinal hybrid. It is cleaned up and polished.

Now it is time for the fifth visit to the restorative dentist. Duringthis visit, the temporary hybrid is removed, and the final hybrid isattached to the patient's mouth with screws. The access holes for thescrews are filled in, and the process is complete.

As can be seen, it takes at least five visits to the restorative dentistto fabricate and install a final hybrid after osseointegration using theimmediate load protocol as currently carried out (i.e., without using aduplicate temporary hybrid). However, often one or more of the visitsmust be repeated because the visit reveals that one of the pieces doesnot fit properly. For example, the verification jig may reveal that thetemporary cylinders in the model do not have the proper spacing andorientation, necessitating at least one extra visit. Or the wax “try in”step may reveal that the occlusion is not correct, necessitating atleast one extra visit. Thus, it often takes more than five visits to therestorative dentist to fabricate and install a final hybrid afterosseointegration using the immediate load protocol as currently carriedout.

Advantages of the Present Invention

In contrast, as described above, only two visits to the restorativedentist are needed when the duplicate hybrid of the present invention isutilized in making a final hybrid. This is because the duplicate hybridmay serve multiple purposes during the fabrication of the final hybrid.First, the duplicate hybrid may serve the same purpose served by the“custom tray” during the immediate load protocol as currently carriedout, which is to hold the impression material that is used to take animpression of the patient's healed gums. Second, the duplicate hybridmay be used to serve the same purpose served by the “verification jig”during the immediate load protocol as currently carried out, which is toverify that the temporary cylinders in the model of the patient's jawbeing repaired are in the proper location and orientation. Third, theduplicate temporary hybrid may be used to serve the same purpose as the“VDO device” (i.e., the base plate with an occlusal rim) during theimmediate load protocol as currently carried out, which is to ensurethat the VDO of the model is correct. Fourth, the duplicate temporaryhybrid may be used to ensure that the centric relation of the model iscorrect. Those skilled in the art will appreciate that the duplicatetemporary hybrid may serve other useful purposes. For example, theduplicate temporary hybrid may be installed in the patient's mouth ifthe original temporary hybrid breaks or becomes damaged in some manner.

In these ways, use of the duplicate temporary hybrid in fabricating thefinal hybrid saves at least three visits to the restorative dentist, andat least approximately 3.5 hours of “chair time” with the restorativedentist. In particular, the need for the second, third and fourth visitsto the restorative dentist under the immediate load protocol ascurrently carried out is eliminated, saving 3.5 hours of chair time (1.5hours for the second visit, 1 hour for the third visit and 1 hour forthe fourth visit). The duplicate temporary hybrid also saves at leastapproximately 4.5 hours of dental laboratory time. In particular, theneed for the dental laboratory time between the first and second visits(2.5 hours) and between the second and third visits (2 hours) under theimmediate load protocol as currently carried out is eliminated.Consequently, the visits to the restorative dentist can occur over asignificantly shorter period of time. Specifically, the visits may occurover a period of a few weeks with the duplicate temporary hybrid ratherthan over a period of several months without the duplicate temporaryhybrid.

Moreover, the “extra” visits that are often needed under the immediateload protocol as currently carried out because one of the pieces (suchas the verification jig or wax “try in”) does not fit properly areavoided with the present invention because such incorrect fits areidentified at the dental laboratory, rather than during a visit to therestorative dentist.

Further Applications for the Present Invention

The present invention has been described above in the context ofreplacing all of a patient's teeth in one jaw (“full arch” toothreplacement). However, the present invention is also applicable insituations where (1) all of the patient's teeth in both jaws are beingreplaced (replacement of both arches), and (2) a patient is having lessthan all of the teeth in one jaw or less than all of the teeth in bothjaws replaced. The present invention has also been described above inthe context of the immediate load protocol (i.e., in a situation where apatient receives a temporary hybrid at the time of the surgical visitwhere the dental implants are implanted). However, the present inventionis applicable whenever a patient receives a temporary hybrid prosthesisand then later receives a final hybrid prosthesis. For example, thepresent invention would be applicable where a patient does not receive atemporary hybrid during the surgical visit when dental implants areimplanted (because, for example, the patient is not eligible for theimmediate load protocol), but rather receives a temporary denture atthat time (which is not attached to the implants but rather is fastenedto the mouth like a traditional denture), and then receives a temporaryhybrid after osseointegration is complete, followed later by a finalhybrid. A temporary hybrid might be used in these circumstances becausethe patient is dissatisfied with having to wear a temporary denture forany longer than is necessary, since the temporary denture is not astightly attached to the patient's mouth as a temporary hybrid (which isscrewed onto the implants).

From the foregoing, it will be appreciated that although specificexamples have been described herein for purposes of illustration,various modifications may be made without deviating from the spirit orscope of this disclosure. It is therefore intended that the foregoingdetailed description be regarded as illustrative rather than limiting,and that it be understood that it is the following claims, including allequivalents, that are intended to particularly point out and distinctlyclaim the claimed subject matter.

What is claimed is:
 1. A method of making a final hybrid prosthesis tobe attached to one or more dental implants in a patient's mouth,comprising: making a temporary hybrid prosthesis to be attached to theone or more dental implants in the patient's mouth, wherein thetemporary hybrid prosthesis comprises a first set of tooth-shapedstructures made out of a first tooth-forming material and a first set ofcylinders, wherein the first set of tooth-shaped structures and thefirst set of cylinders are connected together with a first mass ofacrylic material, and wherein the temporary hybrid prosthesis isconfigured to be attached to the one or more dental implants in thepatient's mouth by a first set of screws that pass through a first setof bores in the first set of cylinders and screw into threads in thedental implants; making a duplicate temporary hybrid prosthesis from thetemporary hybrid prosthesis, wherein the duplicate temporary hybridprosthesis has the same size and shape as the temporary hybridprosthesis, wherein the duplicate temporary hybrid prosthesis comprisesa second set of tooth-shaped structures made out of a secondtooth-forming material and a second set of cylinders, wherein the secondset of tooth-shaped structures and the second set of cylinders areconnected together with a second mass of acrylic material, and whereinthe duplicate temporary hybrid prosthesis is configured to be attachedto the same one or more dental implants in the patient's mouth to whichthe temporary hybrid prosthesis is configured to be attached by a secondset of screws that pass through a second set of bores in the second setof cylinders and screw into threads in the dental implants; and usingthe duplicate temporary hybrid prosthesis in making the final hybridprosthesis while the temporary hybrid prosthesis is attached to the oneor more dental implants in the patient's mouth, wherein the final hybridprosthesis comprises a third set of tooth-shaped structures made out ofa third tooth-forming material and a third set of cylinders, wherein thethird set of tooth-shaped structures and the third set of cylinders areconnected together with a third mass of acrylic material, wherein thethird set of cylinders are connected together by a bar enclosed withinthe third mass of acrylic material, and wherein the final hybridprosthesis is configured to be attached to the same one or more dentalimplants in the patient's mouth to which the temporary hybrid prosthesisis configured to be attached by a third set of screws that pass througha third set of bores in the third set of cylinders and screw intothreads in the dental implants.
 2. The method according to claim 1,wherein the temporary hybrid prosthesis to be attached to the one ormore dental implants in the patient's mouth and the duplicate temporaryhybrid prosthesis are made during or after a dental visit when the oneor more dental implants are implanted.
 3. The method according to claim1, wherein the temporary hybrid prosthesis is made from a denturepreviously worn by the patient.
 4. The method according to claim 1,wherein the duplicate temporary hybrid prosthesis is made during adental visit when the one or more dental implants are implanted.
 5. Themethod according to claim 1, wherein, in response to the duplicatetemporary hybrid prosthesis being made during a dental visit when theone or more dental implants are implanted, no more than two visits to arestorative dentist thereafter are needed to make and install the finalhybrid prosthesis.
 6. The method according to claim 1, wherein, inresponse to the duplicate temporary hybrid prosthesis being made duringa first visit to a restorative dentist after a dental visit when the oneor more dental implants are implanted, exactly one visit to arestorative dentist thereafter is needed to make and install the finalhybrid prosthesis.
 7. The method according to claim 1, wherein the firstset of tooth-shaped structures of the temporary hybrid prosthesis to beattached to the one or more dental implants in a patient's mouthincludes tooth-shaped structures for at least one of a patient's entireupper jaw or entire lower jaw.
 8. The method according to claim 1,wherein the third set of tooth-shaped structures of the final hybridprosthesis includes tooth-shaped structures for at least one of apatient's entire upper jaw or entire lower jaw.
 9. The method accordingto claim 1, wherein the using the duplicate temporary hybrid prosthesisin making the final hybrid prosthesis includes scanning the duplicatetemporary hybrid prosthesis.
 10. The method according to claim 9,wherein the using the duplicate temporary hybrid prosthesis in makingthe final hybrid prosthesis includes scanning a stone/soft tissue modelthat includes a soft-tissue contour after the soft tissue has healedaround the dental implants.
 11. The method according to claim 10,wherein the bar of the final hybrid prosthesis is designed from acomputer model that is derived from the scanning of thestone/soft-tissue model and the duplicate temporary hybrid prosthesis.12. A method of making a final hybrid prosthesis to be attached to aplurality of dental implants in a patient's mouth, comprising: making atemporary hybrid prosthesis to be attached to the plurality of dentalimplants in the patient's mouth, wherein the temporary hybrid prosthesiscomprises a first set of tooth-shaped structures made out of a firsttooth-forming material and a first set of cylinders, wherein the firstset of tooth-shaped structures and the first set of cylinders areconnected together with a first mass of acrylic material, and whereinthe temporary hybrid prosthesis is configured to be attached to theplurality of dental implants in the patient's mouth by a first set ofscrews that pass through a first set of bores in the first set ofcylinders and screw into threads in the dental implants; by use of thetemporary hybrid prosthesis, developing a stone model of the patient'smouth; by use of the stone model, developing a duplicate temporaryhybrid prosthesis, wherein the duplicate temporary hybrid prosthesis hasthe same size and shape as the temporary hybrid prosthesis, wherein theduplicate temporary hybrid prosthesis comprises a second set oftooth-shaped structures made out of a second tooth-forming material anda second set of cylinders, wherein the second set of tooth-shapedstructures and the second set of cylinders are connected together with asecond mass of acrylic material, and wherein the duplicate temporaryhybrid prosthesis is configured to be attached to the same plurality ofdental implants in the patient's mouth to which the temporary hybridprosthesis is configured to be attached by a second set of screws thatpass through a second set of bores in the second set of cylinders andscrew into threads in the dental implants; after soft tissue adjacent tothe plurality of dental implants has healed, attaching the duplicatetemporary hybrid prosthesis to the plurality of dental implants; whilethe duplicate temporary hybrid prosthesis is attached to the dentalimplants, using impression material to identify the contours of thehealed soft tissue; creating an updated stone/soft-tissue model with thehealed soft-tissue contours identified by the impression material; andmaking the final hybrid prosthesis by use of the updatedstone/soft-tissue model and the duplicate temporary hybrid prosthesiswhile the temporary hybrid prosthesis is attached to the plurality ofdental implants in the patient's mouth, wherein the final hybridprosthesis comprises a third set of tooth-shaped structures made out ofa third tooth-forming material and a third set of cylinders connectedtogether with a third mass of acrylic material, wherein the third set ofcylinders are connected together with a bar enclosed within the thirdmass of acrylic material, and wherein the final hybrid prosthesis isconfigured to be attached to the same plurality of dental implants inthe patient's mouth to which the temporary hybrid prosthesis isconfigured to be attached by a third set of screws that pass through athird set of bores in the third set of cylinders and screw into threadsin the dental implants.
 13. The method according to claim 12, whereinthe duplicate temporary hybrid prosthesis is made during a surgicalvisit when the dental implants are implanted.
 14. The method accordingto claim 12, wherein the making of the final hybrid prosthesis includesscanning the updated stone/soft-tissue model and the duplicate temporaryhybrid prosthesis.
 15. The method according to claim 14, wherein the barof the final hybrid prosthesis that is designed from a computer modelthat is derived from the scanning of the updated stone/soft-tissue modeland the duplicate temporary hybrid prosthesis.
 16. The method accordingto claim 12, wherein the temporary hybrid prosthesis is made from adenture previously worn by the patient.
 17. The method according toclaim 12, wherein the updated stone/soft-tissue model is created bymodifying the stone model.
 18. The method according to claim 12, whereinthe updated stone/soft-tissue model includes a stone material portionand a soft-tissue material portion, the soft-tissue material portionmimicking at least a portion of the patient's gingival tissue.
 19. Amethod comprising (i) making a duplicate temporary hybrid prosthesisfrom a temporary hybrid prosthesis, wherein the temporary hybridprosthesis comprises a first set of tooth-shaped structures made out ofa first tooth-forming material and a first set of cylinders, wherein thefirst set of tooth-shaped structures and the first set of cylinders areconnected together with a first mass of acrylic material, and whereinthe temporary hybrid prosthesis is configured to be attached to one ormore dental implants in the patient's mouth by a first set of screwsthat pass through a first set of bores in the first set of cylinders andscrew into threads in the dental implants, and wherein the duplicatetemporary hybrid prosthesis has the same size and shape as the temporaryhybrid prosthesis, wherein the duplicate temporary hybrid prosthesiscomprises a second set of tooth-shaped structures made out of a secondtooth-forming material and a second set of cylinders, wherein the secondset of tooth-shaped structures and the second set of cylinders are heldtogether with a second mass of acrylic material, and wherein theduplicate temporary hybrid prosthesis is configured to be attached tothe same one or more dental implants in the patient's mouth to which thetemporary hybrid prosthesis is configured to be attached by a second setof screws that pass through a second set of bores in the second set ofcylinders and screw into threads in the dental implants, and (ii) usingthe duplicate temporary hybrid prosthesis in making a final hybridprosthesis while the temporary hybrid prosthesis is attached to the oneor more dental implants in a patient's mouth, wherein the final hybridprosthesis comprises a third set of tooth-shaped structures made out ofa third tooth-forming material and a third set of cylinders connectedtogether with a third mass of acrylic material, wherein the third set ofcylinders are connected together with a bar enclosed within the thirdmass of acrylic material, and wherein the final hybrid prosthesis isconfigured to be attached to the same one or more dental implants in thepatient's mouth to which the temporary hybrid prosthesis is configuredto be attached by a third set of screws that pass through a third set ofbores in the third set of cylinders and screw into threads in the dentalimplants.
 20. The method according to claim 19, wherein the temporaryhybrid prosthesis is made from a denture previously worn by the patient.21. The method according to claim 19, wherein the making and the usingcomprise: fabricating, using a denture previously worn by the patient,the temporary hybrid prosthesis; fabricating the duplicate temporaryhybrid prosthesis; attaching the duplicate temporary hybrid prosthesisto the one or more of dental implants in the patient's mouth;identifying contours of healed soft tissue in the mouth of patient usingimpression material; creating an updated stone/soft-tissue model; andfabricating the final hybrid prosthesis using the updatedstone/soft-tissue model and the duplicate temporary hybrid prosthesis.22. The method according to claim 1, wherein the first tooth-formingmaterial and the second tooth-forming material are different materials.23. The method according to claim 12, wherein the first tooth-formingmaterial and the second tooth-forming material are different materials.24. The method according to claim 19, wherein the first tooth-formingmaterial and the second tooth-forming material are different materials.